Randomised controlled trial of health assessments for older Australian veterans and war widows

Julie E Byles, Meredith Tavener, Nick H Higginbotham, Lyn Francis, John E Marley, Rachel L O’Connell, Balakrishnan R Nair, Brendan G Goodger, Claire L Jackson, Mary E McKernon, Richard F Heller and Jonathan Newbury
Med J Aust 2004; 181 (4): 186-190.


Objective: To assess the effect of home-based health assessments for older Australians on health-related quality of life, hospital and nursing home admissions, and death.

Design: Randomised controlled trial of the effect of health assessments over 3 years.

Participants and setting: 1569 community-living veterans and war widows receiving full benefits from the Department of Veterans’ Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942).

Intervention: Annual or 6-monthly home-based health assessments by health professionals, with telephone follow-up, and written report to a nominated general practitioner.

Main outcome measures: Differences in health-related quality of life, admission to hospital and nursing home, and death over 3 years of follow-up.

Results: 3-year follow-up interviews were conducted for 1031 participants. Intervention-group participants who remained in the study reported higher quality of life than control-group participants (difference in Physical Component Summary score, 0.90; 95% CI, 0.05–1.76; difference in Mental Component Summary score, 1.36; 95% CI, 0.40–2.32). There was no significant difference in the probability of hospital admission or death between intervention and control groups over the study period. Significantly more participants in the intervention group were admitted to nursing homes compared with the control group (30 v 7; P < 0.01).

Conclusions: Health assessments for older people may have small positive effects on quality of life for those who remain resident in the community, but do not prevent deaths. Assessments may increase the probability of nursing-home placement.

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  • Julie E Byles1
  • Meredith Tavener2
  • Nick H Higginbotham3
  • Lyn Francis4
  • John E Marley5
  • Rachel L O’Connell6
  • Balakrishnan R Nair7
  • Brendan G Goodger8
  • Claire L Jackson9
  • Mary E McKernon10
  • Richard F Heller11
  • Jonathan Newbury12

  • 1 Faculty of Health, University of Newcastle, Newcastle, NSW.
  • 2 Hunter Area Health Service and John Hunter Hospital, Newcastle, NSW.
  • 3 NHMRC Clinical Tr ials Centre, University of Sydney, Sydney, NSW.
  • 4 Mater Centre for Integrated Health Care and General Practice, University of Queensland, Brisbane, QLD.
  • 5 School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.
  • 6 Department of General Practice, Adelaide University, Adelaide, SA.



The Preventive Care Trial was initiated and funded by the Australian Department of Veterans’ Affairs. We thank Professor John McCallum, scientific advisor for the study. We also thank Associate Professor Cate D’Este, Dr Patrick Fitzgerald and Associate Professor Lynette Lim for statistical advice; and Dr Lynette Mackenzie for developing the HOME FAST tool used in the home-visit checklist.

Competing interests:

None identified.

  • 1. Tulloch AJ, Moore VA. Randomized controlled trial of geriatric screening and surveillance in general practice. J R Coll Gen Pract 1979; 29: 733-742.
  • 2. Stuck AQ, Egger M, Hammer A, et al. Home visits to prevent nursing home admission and functional decline in elderly people. JAMA 2002; 287: 1022-1028.
  • 3. Van Haastregt JCM, Diederiks JPM, van Rossum E, et al. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 2000; 320: 754-758.
  • 4. Cole MG. Impact of geriatric home screening services on mental state: a systematic review. Int Psychogeriatr 1998; 10: 97-102.
  • 5. Byles JE. A thorough going over: evidence for health assessments for older persons. ANZ J Public Health 2000; 24: 117-123.
  • 6. Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 2001; 323: 719.
  • 7. SAS Institute. Statistical applications software, release 8. Cary, NC: SAS Institute, 1999.
  • 8. White S, Freedman L. Allocation of patients to treatment groups in a controlled clinical study. Br J Cancer 1978; 37: 103-115.
  • 9. Byles JE, Tavener M, Fitzgerald P, et al. A checklist for comprehensive health assessment for the over 70’s. Austr J Ageing 2002; 21: 14-20.
  • 10. Lipski PS. Australian Nutrition Screening Initiative. Aust J Ageing 1996; 5: 14-17.
  • 11. Stewart AL, Kamberg CJ. Physical functioning measures. In: Stewart AL, Ware JE Jr (eds). Measuring functioning and well being: the Medical Outcomes Study approach. Durham, NC: Duke University Press, 1992: 86-101.
  • 12. Koenig HG. An abbreviated Mini-Mental State Exam for medically ill older adults. J Am Geriatr Soc 1996; 44: 215-216.
  • 13. Koenig HG, Westlund R, George LK, et al. Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics 1993; 34: 61-69.
  • 14. Byles JE, Higginbotham N, Goodger B, et al. Depression among older Australian veterans and war widows. Int J Behav Med 2000; 7: 256-270.
  • 15. Mackenzie L, Byles J, Higginbotham N. Designing the Home Falls and Accidents Screening Tool (HOME FAST): selecting the items. Br J Occup Ther 2000; 63: 260-269.
  • 16. Ware JE, Sherbourne CD. The MOS 36-item Short Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.
  • 17. Littell RC, Milliken GA, Stroup WW, Wolfinger RD. SAS system for mixed models. Cary, NC: SAS Institute, 1996.
  • 18. Wei LJ, Stram DO. Analysing repeated measurements with possibly missing observations by modelling marginal distributions. Stats In Med 1988; 7: 139-148.
  • 19. O’Brien PC, Fleming TR. A multiple testing procedure for clinical trials. Biometrics 1979; 35: 549-556.
  • 20. Australian Bureau of Statistics. Census of population and housing. Selected family and labour force characteristics. Canberra: ABS, 1996. (Catalogue No. 2017.0.)
  • 21. Australian Bureau of Statistics. National Health Survey. SF-36 population norms, Australia. Canberra: ABS, 1995. (Catalogue No. 4399.0.)
  • 22. Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032-1036.
  • 23. Fox A, Sims S, Farish S, et al. A specialised advisory service for older people and those caring for them. Aust J Ageing 1995; 14: 68-70.
  • 24. Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389-395.
  • 25. Van Rossum E, Frederiks CMA, Philipsen H, et al. Effects of preventive home visits to elderly people. BMJ 1993; 307: 27-32.
  • 26. Newbury J, Marley J, Beilby J. A randomised controlled trial of the outcome of health assessment of people aged 75 years and over. Med J Aust 2001; 175: 104-107.


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